Healthcare Provider Details

I. General information

NPI: 1952371163
Provider Name (Legal Business Name): DAVID R ALLEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2006
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1603 W 4TH ST
HOLTON KS
66436-1153
US

IV. Provider business mailing address

25350 C RD
SOLDIER KS
66540-9306
US

V. Phone/Fax

Practice location:
  • Phone: 785-364-3205
  • Fax: 785-364-3468
Mailing address:
  • Phone: 785-834-2643
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number0427617
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: